Climate Change ECHO: Telementoring to Improve Climate Literacy for Health Professionals

HIGHLIGHTS • The Climate Change and Human Health ECHO (Extension for Community Healthcare Outcomes) program improves knowledge and self-efficacy for clinicians.• ECHO telementoring improves climate literacy for health professionals.• The Climate Change and Human Health ECHO program builds resources and capacity.• The Project ECHO Climate program fills a large educational training gap in climate education.


INTRODUCTION
Climate change is a public health crisis affecting millions of people throughout the world and most often affecting the most vulnerable in the population. 1 There are a plethora of consequential climate-related health impacts, including renal failure and stroke from extreme heat and drought, water-and vector-borne diseases from flooding and temperature variability, and pulmonary and cardiovascular compromise from degraded air quality caused by greenhouse gas pollution and wildfires. 2,3−10 Although the need for climate-related health education is apparent, available trainings are scarce.−13 Recently, many medical and health professional schools are beginning to design evidence-based climate and health education programs. 14,15he weekly Climate Change and Human Health (CCHH) ECHO (Extension for Community Healthcare Outcomes) program began in July 2021 with primary goals to (1) improve knowledge and self-efficacy about climate-related health effects and (2) improve climate change-related communication skills.This program, also called the CCHH ECHO, began 3 months after the success of an 8-week pilot series held from February to April 2021, which offered preliminary data to suggest that climate change telementoring for health professionals is a beneficial and necessary endeavor. 16−19

Curriculum and Weekly Session Format
Given the goals to increase knowledge, self-efficacy, and communication skills, the CCHH ECHO curriculum was developed in concert with experts from the National Oceanic and Atmospheric Administration and the Centers for Disease Control and Prevention 20,21 to train clinicians and public health professionals about best practices to prevent and mitigate climate-related health effects and to impart effective climate and health communication skills.Topics included extreme heat, mental health impacts, degraded air quality, and emergency preparedness.This study was reviewed and approved by the University of New Mexico IRB.
−26 Each 60-minute CCHH ECHO telementoring session included a nationally known subject-matter expert who presented a 25−35 minute, evidence-based lecture, followed by a facilitated question-and-answer session.Some sessions included a live simulated case to illustrate the health-related impacts of climate change as well as the importance of effective communication; others included a skills session to train participants regarding available climate mapping and data access tools for educational use with patients. 23he digital librarian provided all evidence-based references in the chat during the session.Participants could also access the presentation, the video recording, and an updated Zotero resource library on the CCHH ECHO program webpage within a few days of each session completion. 23The ECHO model encourages free use of all materials. 27

Registration
Participants registered before the session by entering their demographics, location, and profession.ECHO sessions were delivered via Zoom (Zoom, Inc., San Jose, CA), which tracks participant attendance.Attendance data were deduplicated using e-mail addresses.ECHO staff, presenters, and hub team members were excluded from the analysis.

Zoom Poll
Zoom polling was used to conduct a real-time evaluation of participant knowledge and self-efficacy pertaining to each session's presentation.Two questions were asked at each session (Table 1).

Postsession Survey
The program provides a weekly, optional survey to participants, who can also claim no-cost continuing education units embedded within the survey.The survey queries participant satisfaction with the session (Did the session meet objectives and was the content balanced and evidence-based?and other questions).Responses from July 21, 2021 to February 9, 2022 surveys were aggregated, and the ECHO evaluation team summarized the number and percentage of specific responses (not unique individuals) (Table 2).

Demographics
During the first 6 months of the CCHH ECHO program, 804 unique participants attended the sessions.The largest percentage of participants (n=188, 37.5%) were from New Mexico; however, participants also joined from 44 other U.S. states, Puerto Rico, and the U.S. Virgin Islands.International participants joined from 25 countries.Many participants identified as nurses/nurse practitioners (n=198, 24.7%), physicians (n=135, 16.8%), or public health professionals (n=68,8.5%).Educators accounted for 7.2% (n=58).Of the participants who selfidentified their gender, there were 51.6% women, 20.5% men, and <1% gender nonconforming or transgender.The largest percentage of participants identified their race as White (n=292, 36.3%),followed by Hispanic, Latino, or Spanish (n=83, 10.3%); Asian or Asian Indian (n=50, 6.2%); African American (n=30, 3.7%); and American Indian/Alaska Native (n=29, 3.6%) (Table 3).Zoom Poll Knowledge and Self-Efficacy Questions Two real-time Zoom poll questions related to knowledge and self-efficacy were asked during each of the 21 sessions.The average response rate for these questions was 54% of the total participants attending the session.Of these respondents, 55.6% strongly agreed, 39% agreed, and 0.8% disagreed that they achieved the session objectives (Table 1).

Postsession Surveys
Participants completed the postsession survey 717 times, for a 31% average response rate.Participants were asked whether the program met the stated objectives, was evidence based, and increased their communication skills.A total of 90% rated the sessions as excellent or very good regarding evidence basis, and 89% rated the sessions as excellent or very good regarding improvement of their communication skills with patients and colleagues.More than 75% of participants selected excellent or very good in response to the other questions asked (Table 2).

DISCUSSION
The CCHH ECHO program has succeeded in improving participant knowledge, self-efficacy, and communication skills while providing interprofessional climate change and health education training to a diverse group of clinicians and public health professionals.For participants who attended regularly, the CCHH ECHO offered a community of practice, a venue for advocacy and coordinated action, and/or an impetus to initiate a climate change-related program of their own.Most participants were nurses/nurse practitioners, doctors, and public health professionals, suggesting a real-world need for clinicians and public health professionals to increase their climate knowledge and communication skills.
A unique feature of the CCHH ECHO was the emphasis on acquiring both knowledge and communication skills related to climate change and health literacy.An example of this from the curriculum is the disaster preparedness section, which trained participants regarding increasing extreme weather events such as hurricanes, floods, abrupt freeze conditions, heat waves, and wildfires while including the communication skills necessary to disseminate relevant and actionable information to their patients.If clinicians and other healthcare and public health professionals are able to teach their patients about best practices in disaster preparedness, individuals and communities can begin to mitigate the adverse health effects of future disasters. 28ecause the ECHO model promotes the diffusion of knowledge and multiplies the dissemination of best practices information, this novel program has proven the potential to benefit many broadly distributed patients and communities. 27The authors believe that participants will proceed to educate both their colleagues and patients about the observed and potential future impacts of climate change on human health.−31.Limitations Because Project ECHO is a voluntary educational telementoring network open to all healthcare professionals, educators, and climate specialists, the program analysis is open to volunteer bias.Participants who volunteered for the program may be more accepting of the topics covered and may be more likely to use the skills covered.However, the ECHO model can examine the benefits to participants' knowledge, self-efficacy, practice change, and improvements in communication skills.The CCHH ECHO is very interested in understanding how this method of climate education can increase capacity for knowledge and practice change given the worldwide climate crisis.
It is also important to note that 29% of participants fell in the other professional category.Although we are unable to confirm, it is reasonable to surmise, given the weekly facilitated discussions, that many participants could be community organizers, health policy leaders, legal advisors, and/or communication specialists.Thus, although the predominant groups of participants are nurses and doctors, it is possible that many other essential groups of climate specialists are joining these sessions.

CONCLUSIONS
Given both the global climate crisis and the identified climate education training gap, this novel CCHH ECHO may continue to be a growing worldwide resource for clinicians, public health professionals, and others in the climate change field.In addition, the CCHH ECHO builds capacity by educating interested learners who can then go on to educate others in this growing field.Future CCHH ECHO studies plan to examine many different aspects of behavior change, including patient education, community outreach, and advocacy.

Table 1 .
Climate Change and Human Health ECHO Curriculum and Zoom Poll Results a

Table 1 .
Climate Change and Human Health ECHO Curriculum and Zoom Poll Results a (continued) (continued on next page)

Table 1 .
Climate Change and Human Health ECHO Curriculum and Zoom Poll Results a (continued) (continued on next page)

Table 1 .
Climate Change and Human Health ECHO Curriculum and Zoom Poll Results a (continued) m, month; d, day; y, year; # number; CDC, Centers for Disease Control and Prevention; ECHO, Extension for Community Healthcare Outcomes.a Data reported are from July 21, 2021 to February 9, 2022.

Table 2 .
Climate Change and Human Health ECHO Postsession Average Survey Responses (N=717 Total Responses) Note: Data reported are from July 21, 2021 to February 9, 2022.ECHO, Extension for Community Healthcare Outcomes.